Medicare Manager Jobs (NOW HIRING)

Resp & Qualifications

PURPOSE:

This role is responsible for managing day-to-day pharmacy operations for the Maryland Medicaid/Medicare plan, providing guidance to and oversight of pharmacy staff, and directing the contracted Pharmacy Benefit Management (PBM) plus other vendor(s) under the general direction of the Director of Government Programs Pharmacy Services. The Medicaid/Medicare Pharmacy Manager is also responsible for providing clinical expertise relative to the pharmacy benefit programs, participating in designing, developing, and implementing clinical programs to promote a quality cost-effective medication use and manages all Pharmacy & Therapeutics related process activities, and leads/supports quality initiatives to improve patient outcomes. The Manager is expected to assist department leadership with development and implementation of strategies, policies, protocols and systems that improve operational productivity, efficiency, and service.

ESSENTIAL FUNCTIONS:

• Respond to the Maryland Department of Health (MDH), U.S. Centers for Medicare and Medicaid Services (CMS), and other federal and state agencies as directed by leadership. Assist in ensuring pharmacy related processes are carried out in accordance with MDH, CMS, and other federal and state requirements and guidance, including executive orders, regulatory requirements, advisories, and administrative rules. Prepare for annual submissions to and respond to other requests from MDH. Oversee the creation and maintenance of the website contents, member/provider/internal communications in accordance with National Committee for Quality Assurance (NCQA) and MDH requirements.

• Collaborate with the Quality and other departments in supporting quality initiatives and other related activities related to HEDIS. Prepare for submission of all questionnaires and reports to MDH.

• Analyze pharmacy and medical utilization data to identify trends and at-risk populations; recommend and develop appropriate interventions; monitor and takes action on results. Identify business process improvements that are aligned with and supportive of business goals and objectives, as well as provide thoughtful analyses and recommendations.

• Oversee the tasks performed by the Pharmacy Management team members. Demonstrates effective performance management of team members and supports activities to maintain a highly functioning team. Make presentations to and develop training, reports, and other communications for internal staff, members, providers, and to other stakeholders related to Pharmacy Management. Create, update and maintain pharmacy program policies and procedures according to NCQA and other governing agency's requirements.

• Analyze pharmacy and medical utilization data to identify trends and at-risk populations; recommend and develop appropriate interventions; monitor and takes action on results. Identify business process improvements that are aligned with and supportive of business goals and objectives, as well as provide thoughtful analyses and recommendations.

SUPERVISORY RESPONSIBILITY:

This position manages people.

QUALIFICATIONS:

Education Level: Pharm.D

Licenses/Certifications Upon Hire Required:

• PHARMD - Licensed Pharmacist

Experience: 5 years in managed care, hospital, or retail pharmacy. 1 year supervisory experience or demonstrated progressive leadership experience.

Preferred Qualifications:

• Minimum two years involvement in formulary development, drug use evaluation, and quality improvement activities

• Experience with developing and implementing clinical programs

• Experience with Medicare Part D and Medicaid guidelines and requirements

• Completion of a pharmacy practice or specialty residency (PGY1 or PGY2)

Knowledge, Skills and Abilities (KSAs)

• Ability to work independently, exercising sound judgment, discretion and the initiative to facilitate change.

• Ability to work well in an interdisciplinary team where you will be frequently asked to help resolve problems, foster an atmosphere of collaboration and teamwork.

• Knowledge of legislative/oversight bodies (e.g., URAC-Utilization Review Accreditation Commission, CMS-Centers for Medicare & Medicaid Services, NCQA-National Committee for Quality Assurance).

• Strong professional writing and verbal communication skills, including analytical abilities and citation skills.

• Working knowledge of pharmacy and its related subdisciplines (therapeutics, pharmacology, physical pharmacy), formulary development, drug use review, quality assurance, legal, regulatory, and standards of practice.

• Ability to research and analyze the medical literature including drug information, disease states, and clinical practice guidelines.

• Must be able to meet established deadlines and handle multiple customer service demands from internal and external customers, within set expectations for service excellence. Must be able to effectively communicate and provide positive customer service to every internal and external customer, including customers who may be demanding or otherwise challenging.

Salary Range: $134,400 - $249,480

Salary Range Disclaimer

The disclosed range estimate has not been adjusted for the applicable geographic differential associated with the location at which the work is being performed. This compensation range is specific and considers factors such as (but not limited to) the scope and responsibilities of the position, the candidate's work experience, education/training, internal peer equity, and market and business consideration. It is not typical for an individual to be hired at the top of the range, as compensation decisions depend on each case's facts and circumstances, including but not limited to experience, internal equity, and location. In addition to your compensation, CareFirst offers a comprehensive benefits package, various incentive programs/plans, and 401k contribution programs/plans (all benefits/incentives are subject to eligibility requirements).

Department

Government Programs Specialty

Equal Employment Opportunity

CareFirst BlueCross BlueShield is an Equal Opportunity (EEO) employer. It is the policy of the Company to provide equal employment opportunities to all qualified applicants without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, age, protected veteran or disabled status, or genetic information.

Where To Apply

Please visit our website to apply: www.carefirst.com/careers

Federal Disc/Physical Demand

Note: The incumbent is required to immediately disclose any debarment, exclusion, or other event that makes him/her ineligible to perform work directly or indirectly on Federal health care programs.

PHYSICAL DEMANDS:

The associate is primarily seated while performing the duties of the position. Occasional walking or standing is required. The hands are regularly used to write, type, key and handle or feel small controls and objects. The associate must frequently talk and hear. Weights up to 25 pounds are occasionally lifted.

Sponsorship in US

Must be eligible to work in the U.S. without Sponsorship

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REQNUMBER: 22046